Epidemic of Diabetes among South East Asians

​​Diabetes mellitus (DM) is a collection of diseases that involve high levels of blood glucose resulting from defects in insulin production, insulin action, or both (American Diabetic Association, 1997).

Diabetes (especially type 2 diabetes – the most common form of diabetes) is a rising health problem for South Asians (from Bangladesh, India, Bhutan, Afghanistan, India, Nepal, Maldives, Sri Lanka, and Pakistan) and those with South Asian ancestry. (But diabetes is not just a South Asian problem, it is an Asian problem! In 2013, approximately 50% of the people of the world with diabetes were located in Asia with India, Indonesia, China, and Japan in the top 10 countries with the most patients with diabetes.) (Diabetes Voice, Volume 59, Issue 1 (March 2014).
 
South Asians (especially Bangladeshis) are one of the most rapidly growing immigrant groups in the US trying to achieve the American dream - finding good jobs, owning a home, and having a higher standard of living. Despite their successes in realizing the dream, South Asian immigrants are finding their health in jeopardy with the type 2 diabetes epidemic.

South Asians living in western countries have a 4–6X higher risk of developing diabetes than other ethnic groups according to some reports. South Asians also tend to develop 5-10 years earlier than the general population. Furthermore, they develop diabetes at a lower body mass index (BMI) than the general population.

Risk Factors for both Pre-diabetes and Type 2 Diabetes:
      Obesity or Overweight
      Family members with Diabetes
      High triglycerides (> 250 mg/dl) and low HDL cholesterol (< 35 mg/dl)
      High blood pressure (≥ 140/90 mmHg).
      Having had gestational diabetes
      Having had a baby weighing > 9 pounds at birth

​And… belonging to one of these minority groups: Native Americans, African-Americans, Hispanic Americans/Latinos, or Asian-American/Pacific Islanders. 

                                               Obesity and type 2 Diabetes:
Evidence exists supporting increased risk for type 2 diabetes in persons who are obese. In fact, type 2 diabetes is linked to obesity more than any other risk factor.
Greater than 80% of people with type 2 diabetes are either overweight or obese. Approximately 9 out of 10 newly diagnosed diabetes patients are overweight.

 Why is Weight a Risk Factor?

Extra body fat causes the body to have difficulty using its own insulin to affect blood glucose and keep it within normal circulating levels.

Reasons for difficulty controlling blood glucose in people with extra body fat:

1. Fewer available insulin receptors in overweight people. Fat cells have fewer insulin receptors than muscle cells. So - in people who carry extra body fat, there are fewer places in the body where insulin can bind to cells. Normally, once insulin binds to a cell, the cell can use glucose in the blood for energy. If insulin cannot bind as well overall, the cell cannot pull glucose (sugar) out of the bloodstream and use it for of energy. This is called insulin resistance.
2. Having more body fat means requiring more insulin. An organ called the pancreas produces insulin. It has to produce more and more insulin as the body’s mass increases – in order to “feed” the larger mass of the body. But fat has fewer insulin receptors so a vicious cycle begins – more insulin is produced, but there is resistance to insulin so sugar levels rise in the blood. Excess blood glucose is stored as fat which begins the whole cycle again!
3.  Fat cells release free fatty acids (FFAs).   Excess fat, especially in the abdomen, causes the release of free fatty acids, which also interfere with the metabolism of glucose.

                                   How do you measure your body fat?

Body Mass Index (BMI) is a practical way to assess body fat. BMI provides a more accurate measure of total body fat compared to body weight alone. Below is an easy method for calculating BMI:
(Ex: for a person who is 5 feet 5 inches tall and weighs 180 pounds).
     1.    Multiply weight (in pounds) by 703
            180 x 703 = 126,540
 
     2.    Multiply height (in inches) by height (in inches)
            65 x 65 = 4,225
 
     3.    Divide the answer in step 1 by the answer in step 2 to get the BMI
            126,540/4,225 = 29.9
            BMI = 29.9